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Making sense of healthcare report cards

What the ratings really mean for Community Hospital

Two recent “report cards” on hospital quality have given high marks to Community Hospital of the Monterey Peninsula.

Healthgrades, one of the oldest and best-known hospital rating firms, recognized Community Hospital with more than a dozen awards, including ranking its cardiac, orthopedic, and spine surgery programs among America’s 100 Best Hospitals, and patient safety in the top 5 percent in the nation with the Patient Safety Excellence Award™ for 2 years in a row, 2011-2012.

The Leapfrog Group, a national nonprofit made up of employers and other large purchasers of health benefits, has awarded Community Hospital an ‘A’ Hospital Safety Score, based on 26 measures representing a hospital’s overall capacity to keep patients safe from infections, injuries, and medical and medication errors.

These healthcare quality ratings began to appear in the 1990s and have recently turned into an avalanche. In addition to the Healthgrades and Leapfrog ratings, you can find hospital reviews everywhere, including Angie’s List, U.S. News and World Report, Hospital Compare, and Consumer Reports.

At Community Hospital, we think the added focus on safety and quality is a good thing. We encourage patients and their family members to be informed consumers. We strongly support efforts to make information about safety measures and outcomes transparent and accessible. Sharing meaningful information enhances communication between patients and their healthcare providers, which, in turn, increases safety.

And while we are extremely proud that some of our achievements are being recognized, we want to caution that the methodology for rating hospital quality is far from perfect.

When Leapfrog Group released a report on patient safety in hospitals in June of this year, Community Hospital received an “average” rating. In November, we got an ‘A.’ Why did Community Hospital move up two grades in less than six months? The Leapfrog report gives more weight to data reported directly to them, instead of objective data gathered by regulatory agencies. So in the June grading period, Community Hospital did not supply its data directly to Leapfrog, and got a ‘C.’ In the second period, Community Hospital did supply its data — the very same data — directly to Leapfrog, and got an ‘A.’

Again, we’re grateful for the recognition, but very mindful of the need to look under the hood of any hospital rating scheme available today. Consumer Reports (CR), in its August 2012 edition, published its first hospital safety ratings report — which unfortunately was based, in part, on the imperfect data that had been gathered by Leapfrog in its first grading period. Further, CR used mortality data that the federal government’s Centers for Medicare and Medicaid Services will no longer be reporting because the measure is flawed, prone to manipulation, and misleading.

The use by CR of secondary data to determine their ratings is a significant change from their tried-and-true method of doing their own testing and and/or data collection — a methodology that has earned them considerable public trust. This time, they didn’t do that. Only 18 percent of all U.S. hospitals were rated by CR. Community Hospital was once again rated “average” with a score of 46, one point off the median score for the 168 California hospitals rated.

Healthgrades, on the other hand, reviews data submitted by hospitals to the federal government. For its 2013 hospital quality outcomes analysis, Healthgrades evaluated approximately 40 million Medicare hospitalization records for services performed from 2009 through 2011 at approximately 4,500 short-term, acute care hospitals nationwide. From that data, though, Healthgrades applies its own proprietary methods to arrive at its rankings. Because their methods aren’t disclosed publicly, it is impossible to judge their validity.

With the growth in information sources, what is a concerned consumer to do? Talk with people who have experience with the kind of care you require. Talk with healthcare professionals who have experience with the hospital you are considering. Of course, you should also review the various online resources. But remember that all currently available hospital report cards have flaws.

Whatever the information source, you will find that no hospital — including Community Hospital gets perfect grades. Still, we continually strive for excellence by routinely working with organizations like the American College of Cardiology, the Society for Thoracic Surgery, and the Joint Commission, organizations that use proven methods and provide in-person evaluations.

Please know that we at Community Hospital are deeply aware of our need to continuously improve and to constantly provide high-quality, safe, reliable care to our community. Our current initiatives to eliminate preventable patient harm include our Joint Commission-certified stroke program, a bar-coded medication administration system that ensures patients receive the right medication at the right time, and a campaign to prevent falls, among many others.

With or without report cards, we’ll never stop working to improve. It’s just another day at Community Hospital.